“Ninety percent of people over 60 years of age have
abnormal MRIs. I always tell patients, we’re not here to
treat your MRI — we are treating you,” Su says. Accordingly,
the American Academy of Family Physicians recommends
against doing a scan within the first six weeks of back pain,
in the absence of red flags such as trauma or fever.
And so many patients complain they still have back
pain after a surgery that it’s understandable why Su — and
pretty much all medical authorities — recommend trying
just about anything else to ease chronic back pain before
considering surgery. ( This is assuming your doctor has ruled
out an injury like a fracture or illness such as cancer or a
rare emergency disorder known as cauda equina syndrome.)
A prescription is rarely the answer either. The use of
painkillers for chronic pain is rapidly falling out of favor
now that the opioid crisis has made apparent the outsize
risks of OxyContin and similar drugs. When Woods was
arrested after being found asleep at the wheel earlier this
year, six weeks after his fourth back surgery, he was found
to have t wo opioid drugs in his system. He later completed
a drug treatment program.
Su’s practice has “drastically” reduced prescriptions of
opioids, with the exception of postsurgical patients, he says.
With surgery and painkillers off the table for most
patients, what to do about the persistent pain that can make
it difficult to sit, work, even sleep? Fortunately, you don’t
have to give up and bear it. There are noninvasive treatments that patients say really help.
HEAT, MASSAGE, CHIROPRACTIC CARE
These are first on the American College of Physicians’ 2017
guidelines for treating acute and chronic low back pain.
While there isn’t strong evidence behind these treatments’
effectiveness, the risks are low and doctors say they’ve seen
some patients benefit. For chiropractic care, Su recommends muscle release over adjustments.
If you hurt your back and the doctor recommends ibupro-
fen or aspirin, pay close attention to the dose the physician
recommends — it’s probably a higher dose, for a longer dura-
tion, than you’d think.
“The mistake most patients make is that they pop a cou-
ple ibuprofen and say they feel a little better, and then that’s
all they take,” Su says. “Even if you don’t have pain, take it.
Because it builds a baseline level of anti-inflammatory in
your blood, and that actually treats the inflammation.”
Of course, all drugs have side effects and risks. The Food
and Drug Administration has warned that nonsteroidal
anti-inflammatory drugs including ibuprofen can increase
the risk of heart attack or stroke, so don’t start a regimen
without consulting your doctor.
Osteopathic physicians undergo a different training protocol than medical doctors, with a focus on the whole person.
Some specialize in manual therapy, using their hands to
manipulate the patient’s body. If you bring your aching back
to an osteopath such as Novato’s Dr. Maud Nerman, you can
expect the physician to feel your back and hips for out-of-place parts and gently guide them back into position.
“About 70 percent of the time that somebody has low
back problems, the sacrum is in the wrong place,” Nerman
explains. “It’s either pushed up, which would squeeze the
lumbar disks, or it’s at an angle — which can happen if
there’s a fall or a car accident. Most of the time when you
get the sacrum back in place, the back pain goes away.”
A 2013 review of the research on osteopathic interven-
tion for chronic low-back pain found some evidence for
effectiveness, but called for more rigorous clinical trials.
While more commonly used for nerve pain, such as sciatica, steroid injections are one option Su’s clinic sometimes
offers to temporarily ease lower-back pain. Even though the
Journal of the American Medical Association recommends
against these injections for back pain alone, Su has found
they can bring short-term relief for an injury to or arthritis
in the spinal joints. But he advises against repeated use,
which can cause a loss of bone density.
PHYSICAL THERAPY AND EXERCISE
While many physicians prescribe physical therapy to teach
patients pain-relieving stretches and exercises, the research
doesn’t conclusively support it: a 2015 study found only a
small difference in the recovery of patients who attended
four PT sessions and those who didn’t. The PT patients did
recover their ability to move freely more quickly, but there
was no difference in pain.
Still, it could be the typical PT regimen just doesn’t cut
it. In 2008, Marin investigative reporter Cathryn Jakobson
Ramin set out to find the solution to the back pain that was
holding her hostage; later she chronicled the effort in her
2017 book Crooked: Out witting the Back Pain Industry and
Getting on the Road to Recovery. Ramin, who tried pretty